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General NPI Number Information
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NPI Number | 1194675876
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Entity Type | Individual
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Provider Name | CONSTANTIN JITARU
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Gender | Male
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 770 ROOSEVELT TRL STE 8
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City | N WINDHAM
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State | ME
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Zip | 04062-5300
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Country | US
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Telephone | 207-713-0263
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Fax |
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Provider Business Mailing Address
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Address Line | 770 ROOSEVELT TRL STE 8
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City | N WINDHAM
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State | ME
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Zip | 04062-5300
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Country | US
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Telephone | 207-713-0263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | ME
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